Braving the Low Vision Exam

by Cydney Strand, R.N.

“But I thought you were going to help me,” implored Mrs. Kern as I began showing her how to use her new spectacles. The examination part of her low vision visit had concluded, and Mrs. Kern had felt optimistic. Unlike her last eye exam, at which she could barely see the large “E” at the top of the eye chart, she had just read three full lines of the low vision eye chart. Maybe things were improving, she thought.

Now, in the instruction room of the low vision clinic, we werefollowing the doctor’s recommendation and working with a pair of spectacles that gave Mrs. Kern the ability to read the newspaper – but it meant having to hold the paper six inches from her face. And when she looked up at me, everything was out of focus again. Why did these glasses only work up close? Again, she protested, “I thought you were going to help me!”

“It’s not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”
Charles Darwin

The misunderstanding of what low vision care is – and is not – often causes confusion and frustration. Low vision care is about rehabilitation, not cure. It’s about finding new ways to accomplish the tasks of daily life – whether it’s writing a grocery list, watching a grandchild play soccer or reading a menu in a restaurant.

A low vision examination, often the first step in vision rehabilitation, is designed to accurately measure how one’s vision works in the real world – how it functions in day-to- day living. It’s not only about how well you can see an eye chart, but also how well you can see faces, street signs, newspaper print, stove dials, and all the other visual clues that guide you through the day. The low vision clinician uses special charts to measure how well you see, both at a distance and up close. Additional vision tests measure contrast sensitivity and locate blurry or distorted areas in the visual field.

You will also be asked specific questions about your vision. Are you affected by glare – outdoors, indoors, or both? Do you have difficulty seeing under different lighting conditions? Do you see better on sunny days or cloudy days? How do you describe your ability to see contrast, such as a light sweater lying on a white bedspread? Are there any blurry or distorted areas in your vision? Where are they? Do you see better when you look slightly away from the object?

Additional questions address your ability to manage activities and tasks of daily living. Expect to discuss with the low vision specialist how your impairment impacts your life. Do you travel independently? Can you safely prepare your own meals? What about grocery shopping, making phone calls or taking medications? Can you write checks and manage other financial tasks? How does your vision loss affect your participation in leisure pursuits or in employment-related activities? Do you have any special or unusual hobbies that will need some creative solutions?

The information gathered during a low vision examination enables the doctor to prescribe the device(s) that will best meet your individual needs.

Device selection is based on several considerations:

How strong a lens do you actually need?
Can you use a weaker lens for some tasks?
How and where will you use the device?
Do you plan to carry it with you, or will it sit on your desk?
With what kind of activity will the device assist, and how close can you get to the task at hand? Very close (reading a newspaper), not too close (cooking an omelet), or not close at all (watching a theater performance)?
Do you need your hands to be free while doing the task, or can you hold a magnifier?
Are safety issues involved?
How big are the items you wish to see?
Can the activity be made easier with better use of lighting, controlling glare or increasing contrast?

While your doctor may suggest many options for devices, the final choice is yours. You’ll also receive instruction in how to use them and have time for practice. Getting accustomed to using most devices often requires additional practice at home.

Stronger Isn’t Always Better!

A strong magnifier can be difficult to use. It must be held very close to the object it’s magnifying, and even the slightest motion can cause it to lose focus. The size of the area that can be viewed is also reduced as the magnifier gets stronger. In fact, the “best” magnifier is usually the weakest one that still allows you to accomplish a specific task. Sometimes it’s even necessary to practice with aweaker magnifier in order to develop the skill to use a stronger one.

Lighthouse International, “Sharing Solutions”, Fall 2000
The Health Library at Vista Center.